Dupuytren’s disease is a condition where thickening of the fascia (a layer of tissue beneath the skin) in the palm of the hand and sometimes the sole of the foot occurs. It starts as a nodule and progresses to a thick cord which can eventually pull the finger(s) into the palm. The pace of progression varies from person to person. It can run in families and is more common in Western Europeans especially those of Celtic and Scandinavian origin. Surgery is usually reserved until a contracture of the finger has taken place.
Surgery involves removing the involved fascia and straightening the finger. This is called a fasciectomy. If the skin is very heavily stuck to the diseased fascia and/or the problem has recurred after previous surgery, it may need to be removed as well and replaced with a skin graft. This procedure is known as a dermofasciectomy. After surgery, hand therapy is usually needed to regain as much movement as possible in the affected fingers and to maintain their ability to straighten out. It is often necessary to wear a splint at night for up to three months after surgery. When a finger is very severely affected and bent right down into the palm, it is not always possible to fully straighten it with surgery.
A newer treatment is now available for some cases of Dupuytren’s disease. An enzyme called collagenase (Xiapex®) is able to breakdown the collagen in the Dupuytren’s cord. It can be injected into the affected area of the hand in the clinic consultation room. It is quite common for bruising and swelling of the hand and even back up the arm to occur after this stage. For the second stage, 24 to 72 hours later the area is manipulated under local anaesthetic to release the cord. It may have an audible snap at the time of release. This technique is showing great promise and is replacing surgical operations for many patients.
Regardless of the technique used to treat it, Dupuytren’s disease can recur or new disease can appear in other areas of the palm and fingers.